Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC003913L | PA |
NPI | 1013976992 |
---|---|
Provider Name | Michael Raymond Ames |
First Address | Quakertown, PA 18951-1424 |
Second Address | Quakertown, PA 18951-1424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 04/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0386044000 | KEYSTONE/ BC & BS (01) | PA |
2048415 | AETNA (01) | PA |
50004518 | CAPITAL BLUE CROSS (01) | PA |